Study identifies why some hepatitis D patients naturally beat infection
Researchers tracked 1,610 chronic hepatitis D patients and found that 8.4% achieved spontaneous viral suppression over four years—a rare outcome that was more likely in diabetic men with lower initial viral loads. The findings could help doctors identify which patients might recover without treatment, potentially reducing unnecessary interventions and healthcare costs.
Originaltitel: Diabetes, male sex, low levels of HBsAg, HDV RNA and ALT predict spontaneous HDV suppression in chronic hepatitis D
BACKGROUND AIMS: Persistent HDV replication is associated with severe liver disease, yet predictors of spontaneous HDV RNA suppression remain poorly defined. We assessed the incidence and predictors of spontaneous HDV suppression in a large cohort of chronic hepatitis D (CHD). METHODS: We included 1,610 adult, treatment-naive CHD patients with ≥3 HDV RNA tests, who attended the Liver Center, Mongolia, between 2015-2025. Patients were categorized according to the last HDV RNA result: 1. Suppression (HDV RNA <50 IU/mL or HBsAg loss), 2. Persistent infection (HDV RNA ≥50 IU/mL). The incidence and predictors of HDV suppression during follow-up were analyzed using Kaplan-Meier curves and Cox regression. RESULTS: The median baseline age was 40.5 years, and 44.5% were male. Over a median of 3.9 years (IQR=2.1-5.9), 136 patients (8.4%) achieved spontaneous suppression, yielding cumulative incidences of 7.8% and 23.3% at 5 and 8 years, respectively. Independent predictors of HDV suppression were diabetes (adjusted hazard ratio [aHR] 2.13; 95% CI 1.21-3.74) and male sex (aHR 1.61; 95% CI 1.19-2.40), whereas higher baseline levels of HBsAg (aHR 0.42; 95% CI 0.31-0.55), HDV RNA (aHR 0.74; 95% CI 0.62-0.89), and ALT (aHR=0.35, 95% CI 0.21-0.57) were negatively associated. The risk of liver-related events was significantly lower in in patients with HDV suppression than in those with persistent replication (p=0.03). CONCLUSION: Diabetes, male sex, lower baseline HBsAg, HDV RNA and ALT independently predicted HDV spontaneous suppression. These factors may inform treatment decisions in this era of emerging anti-HDV therapies.